Clarissa Schmal discovered her interest for politics and the UN when she joined the Model United Nations club at her school in Denmark.
Access to Healthcare in African LEDCs
Since the proclamation of the Declaration of Human Rights in December 1948, health and medical care have been defined as fundamental human rights. The United Nations have further devoted themselves to ensure these rights and aspire towards their universal recognition and observance. However, healthcare is far from being self-evident in many countries. Especially in African LEDCs, local healthcare systems are immensely challenged by the lack of clean water and sanitation facilities, epidemics such as the human immunodeficiency virus (HIV), and the continuous shortage of trained healthcare professionals. Moreover, high costs and infrastructural issues prevent many people from obtaining healthcare. Therefore, the efficient access to healthcare is widely regarded as one of the biggest issues African LEDCs are facing. In 2015, fewer than 50% of the African population had access to modern health facilities, demonstrating that it is currently beyond the bounds of possibility to use existing facilities effectively. To combat this issue, the international community has defined “achieving access to quality essential healthcare services” as part of Goal 3 of the Sustainable Development Goals that are to be reached in 2030. Consequently, measures leading to considerable improvements of the situation must be worked on and implemented now. But why is the issue still unsolved even though it has been on the agenda of the international community for such a long time? When will there finally be concrete actions to combat the issue?
What Is Access? And What Is Healthcare?
Before the obvious lack of access to healthcare can be criticized, it is essential to be aware of what healthcare is and what it means to have access to healthcare.
According to the Cambridge Dictionary, healthcare is a service that is either provided by a country or an organization. This service will support a mentally or physically ill person in improving or at least maintaining the medical condition by providing a diagnosis, treatments and prevention. The Declaration of Alma-Ata further defines primary healthcare as essential healthcare at a cost that can be afforded by a community or country at every stage of their development..
A team of scientists of the Department of Public Health Sciences of the King’s College in London published a study concerning the meaning of access to healthcare in 2002. It demonstrates that access to healthcare is only guaranteed if there is an adequate supply of services and the opportunity to obtain healthcare for the population. To have this opportunity, the affordability, physical accessibility and acceptability of the healthcare services must be ensured.
What Has Been Done so Far?
After the definition of medical care and health as fundamental human rights had formed the basis for the entitlement of every person to healthcare, the devotion of the international community to ensure health care has been renewed in several treaties and declarations. Among these are the Declaration of Alma-Ata that ensured the international commitment to solving the issue and the International Covenant on Economic, Social and Cultural Rights defining specific measures such as the reduction of infant mortality, improvement of hygiene and the prevention of epidemics. The improvement of health has further been part of the United Nations Millennium Development Goals and is now an essential part of the Sustainable Development Goals.
Timeline of Events
|Date||Description of event|
The Universal Declaration of Human Rights defining medical care and health as human rights is proclaimed and adopted by the General Assembly.
The Declaration of Alma-Ata emphasizes that healthcare is a human right and defines measure to implement universal primary healthcare.
The Bamako Initiative, that was sponsored by UNICEF and the WHO, is adopted by African ministers of health in order to solve the problem of lacking resources.
Members of the African Union pass the Abuja Declaration that defines the target of allocating at least 15% of their annual budget to improve the health sector. Ten years later only one African country reached this target and only 26 countries increased the proportion of government expenditures allocated to health.
The Global Monitoring Report Tracking Universal Health Coverage
Despite of the large number of declarations and treaties, a global monitoring report, that was published by the WHO and The World Bank in 2015, showed that 400 million people worldwide still lack access to essential health services. The fact that further monitors of the situation estimated that this number is too low, conveys that the goal to achieve universal healthcare is far from being reached although it has been on the agenda of the international community for almost 70 years. Furthermore, the 400 million people lacking access to healthcare are evidently not equally distributed among countries. Sub-Saharan African countries are left behind for several basic health services. This is further demonstrated in the following chart (Figure 1) showing the development of coverage for essential health services from 2000 to 2013.
Analysis of the Report - What Do the Results Tell Us?
To investigate the global access to healthcare, the monitoring report defined different categories such as skilled birth attendance, child immunization, antiretroviral therapy, tuberculosis treatment, access to clean water and sanitation and family planning. The major identified obstacles that prevent people from accessing healthcare are the lack of quality health services, long distances to the nearest health facility, restricted opening hours or overcrowded facilities that impose long waiting times, high costs and a lack of information on available services. Besides, the lack of confidence in facilities and staff and sociocultural barriers including constraints related to gender or age, beliefs and cultural preferences are a barrier for many patients. Another alarming fact is that access to healthcare is not distributed equally within countries either. Across low- and middle-income countries, the median coverage of the rural population with skilled birth attendance, family planning services, sanitation facilities and drinking water is below 80%.
Moreover, the report found that 6% of the people in low- and middle- income countries are pushed further into extreme poverty because of health spending.
Which Impact Can Financial Burdens Have?
A huge barrier preventing people from seeking vital health care services is the financial accessibility. In many African countries, a social security system comparable to the insurance systems in many European countries such as Denmark or Germany is not warranted. Hence, individuals have to pay healthcare providers directly in order to receive health services. These payments are often referred to as out-of-pocket payments and impose high financial burdens on the population. Figure 2 demonstrates that in many African countries such as Mauritania, Chad and Sudan more than 45% of the total expenditures on healthcare are out-of-pocket payments. If expenditures on healthcare become inevitable, many people are pushed further into poverty. Therefore, costs can restrict the access to healthcare even if the physical accessibility is ensured.
Has There Been Any Progress Over the Past Decades?
Although the actions taken by the international community have often been criticized, progress can be seen regarding different diseases. Since 2003, the coverage of sub-Saharan African countries with antiretroviral therapy, a therapy used to suppress HIV, has increased immensely. Seven African countries reported the achievement of a coverage rate of 50% or higher and Botswana could even accomplish a rate of 70%. On the other hand, 3 out of the 4 countries facing the largest number of people infected with HIV are still located in Africa. Amongst them is Nigeria with a coverage of only 20%. Another improvement can be seen regarding tuberculosis diagnosis and treatment. Since effective case detection is crucial in combating tuberculosis, it is promising to see that the case detection rate rose from 40% in 2000 to 64% in 2013. A last achievement has been made in the use of insecticide treated bed nets that are amongst other things preventing malaria epidemics. Due to promoting efforts and increased access to the nets, the coverage rates have been increased considerably.
However, further efforts are still essential!
Healthcare in Africa - quiz
For each question, choose the best answer. The answer key is below.
- How many employees does the WHO have?
- In how many different countries does Doctors Without Borders provide medical aid?
What Can Be Done to Ensure Access to Healthcare in the Future?
When looking for possible solutions, it is crucial to remember that access does not only concern infrastructural impediments such as the lack of streets or long distances but also overcrowded facilities, costs, a lack of information on available services, a lack of quality health services and socio-cultural barriers.
However, the most important aspect would be that the international community finally starts working on concrete actions that will truly help the population in African LEDCs. It is not sufficient to pass declarations that do not result in improvement. The population in Africa is waiting for the UN to stop the tendency for defining agendas at the expense of delivering results.